Provider Demographics
NPI:1144271867
Name:NOLL, LAUREEN JUDY (MD)
Entity type:Individual
Prefix:MS
First Name:LAUREEN
Middle Name:JUDY
Last Name:NOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LAUREEN
Other - Middle Name:NOLL
Other - Last Name:VILAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20 POWDERHORN RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-3399
Mailing Address - Country:US
Mailing Address - Phone:864-963-3421
Mailing Address - Fax:
Practice Address - Street 1:20 POWDERHORN RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3399
Practice Address - Country:US
Practice Address - Phone:864-963-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD176962084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE0501OtherMEDCOST ID #
NC274073OtherUNITED BEHAVIORAL HEALTH
NC5901246Medicaid
NC2015854OtherCIGNA ID #
NC1388NOtherBCBS OF NC ID#
NCE62929Medicare UPIN
NC274073OtherUNITED BEHAVIORAL HEALTH